Analysis On Resource Allocation Of Basic Medical Institutions In Guangdong Province From The Perspective Of Hierarchical Diagnosis And Treatment

BackgroundThe 2019 was the ending battle of Guangdong Province’s three-year struggle to strengthen community-level medical services.At present,medical reform is already in full swing in Guangdong Province,and a series of measures have been adopted to promote orderly medical treatment of patients.However,with the gradual penetration of system reform in medicine,the restrains of deep-seated systems and mechanisms are becoming increasingly prominent and benefit structure is adjusting and differentiating profoundly.Today,the problem of difficult and high cost to access medical service is still prominent.ObjectiveTo understand the resource allocation status of basic medical institutions in Guangdong Province,to comprehensively evaluate the medical benefits of Foshan’s basic medical institutions and to find out the main problems and influencing factors existing in the basic medical institutions.Hopefully it will provide a reference for improving the capacity of basic medical institutions services,strengthening community-level construction and improving the system of tiered diagnosis and treatment.MethodsBy using the 2015-2019 Guangdong Health Statistics Yearbook and collecting the data of basic medical institutions in Foshan from 2015 to 2019,descriptive statistical analysis was used to analyze the resource allocation status of basic medical institutions in Guangdong Province.Entropy weight method and improved TOPSIS method were used to comprehensively evaluate the medical benefits of basic medical institutions in Foshan,and the main problems and influencing factors of basic medical institutions were excavated by typical empirical research and group interview.Results1.From 2015 to 2019,the average annual growth rate of the number of basic medical institutions and the number of beds in Guangdong was 3.20% and 2.85%,respectively,both much lower than that of hospitals;In 2019,there were 4.73 beds per 1,000 resident population in Guangdong Province,including 3.84 beds in hospitals and 0.62 beds at grassroots level,both of which failed to meet the national planning requirements.2.From 2015 to 2019,the absolute number of health technicians,licensed(assistant)physicians and registered nurses in hospitals and basic medical institutions in Guangdong Province has been increasing year by year,with the ratio of doctors and nurses of hospitals increasing from 1:1.43 to 1:1.51,and the ratio of doctors and nurses of basic medical institutions increasing from 1:0.66 to 1:0.82,a slow increase year by year.However,the problem of inversion ratio of doctors and nurses has not been reversed.In 2019,the number of health technicians,licensed(assistant)physicians and registered nurses per 1,000 permanent residents at the grassroots level in Guangdong was 2.09,0.96 and 0.79,respectively.3.From 2015 to 2019,the number of total patients in medical institutions in Guangdong Province increased year by year,with an average annual growth rate of 3.09%,including 3.11%in hospitals and 2.82% at grassroots level;In 2019,the total number of grassroots consultations in Guangdong accounted for 49.1 percent of the total number of medical consultations in medical institutions,far below the national requirements;From 2015 to 2019,the average annual growth rate of the number of hospital admissions in hospital was 6.93%,and the proportion also increased,from 77.8% to 80.7%.The average annual growth rate of the number of patients admitted to basic medical institutions was 0.01%,but the proportion decreased from 14.2% to11.3%.The utilization rate of hospital beds was 83.3% on average,and 52.9% at the grass-roots level,which was much lower than that in hospitals.4.From 2015 to 2019,the number of hospitalized patients,discharged patients and diagnostics increased year by year in Sanshui District and Gaoming District,Foshan.However,the number of patients transferred from the grassroots level to the hospital and the number of patients transferred from the hospital to the grassroots level increased from 83.3 times to 667.6times in 2019;In 2019,the ratio of doctors and nurses was 1:0.88 in Sanshui District and Gaoming District,Foshan.The majority of licensed(assistant)physicians and registered nurses have worked for 10-19 years,and rate of senior and deputy senior are low;The number of licensed(assistant)physicians and health technicians per 1,000 resident population ranked first and second.However,there were only 0.96 licensed(assistant)physicians and 0.79 registered nurses per 1,000 resident population in 2019.The comprehensive benefits of basic medical institutions in Foshan present the trend of growth from 2015 to 2019,with the best in 2019 and the worst in 2015.Conclusion1.Some remarkable efforts has been made in strengthening basic medical institutions.However,the service capacity of primary medical institutions is low,and there is a large space for community-level medical and health care services;The medical resources are inadequate and unevenly distributed,and there is a lack of talents,rare reserve of talents and serous disconnects in basic medical institutions.2.Backward information construction hinders two-way referral;Medical service community,community family physician services and medical insurance payment have not yet formed effective guidance and control of the hierarchical diagnosis and treatment.3.It is necessary to further integrate the medical and health service system and optimize the allocation of medical and health resources.Strengthen the grassroots talent team construction and improve the grassroots medical service ability;Build a health information sharing platform and accelerate the pace of information construction;We should continue to promote the role of the medical service community,community family physician services,and medical insurance payments in promoting tiered diagnosis and treatment.